Objective: Transcatheter cardiac occluder therapies, including left atrial appendage closure for atrial fibrillation and patent foramen ovale (PFO) closure for cryptogenic stroke, are minimally invasive procedures. They are highly standardized and typically performed under sedation with transesophageal echocardiography guidance to ensure accurate device placement. While sedation enhances patient comfort, it also poses risks such as hypotension, hypoventilation, hypoxia, and aspiration, particularly in elderly patients with comorbidities. Optimal pharmacological sedation management is therefore essential. Current guidelines recommend general anesthesia or propofol-based sedation. However, sedation protocols are not uniform across centers, and clinical trials comparing different sedation strategies in transcatheter occluder procedures remain scarce.
Methods and results: In a retrospective analysis 82 procedures performed from 2024-2025 were analyzed: 30 in the ketamine–propofol group (KP), 30 in the propofol–fentanyl group (PF), and 22 with propofol alone (P). Mean age was 75 ± 12 (KP), 70 ± 13 (PF) and 67 ± 16 years (P). All procedures were technically successful without conversion to general anesthesia. Hypoxia (SPO2 <90%) occurred in 33% (KP), 43% (PF) and 50% (P). Respiratory rescue interventions were required in 30% (KP), 37% (PF) and 36% (P) of cases. Hypotension (<100 mmHg) was observed in 7% (KP), 13% (PF) and 14% (P). Hemodynamic rescue interventions were necessary in 0% (KP), 10% (PF) and 5% (P). Sedation duration, time to transseptal puncture and overall procedure time showed no significant differences among KP, PF and P. Operator satisfaction was highest in the KP group due to greater hemodynamic and respiratory stability.
Conclusion: This retrospective analysis indicates that ketamine–propofol (KP) sedation is associated with lower rates of hypoxia and hypotension compared to propofol–fentanyl (PF) and propofol alone (P), while procedure duration and success rates remained similar. Hemodynamic stability and operator satisfaction were highest in the KP group. However, due to the retrospective design and limited sample size, the findings should be interpreted with caution and cannot establish causality. Prospective, randomized trials are needed to confirm these results and to support standardized sedation protocols for transcatheter occluder procedures.
